Coronary angiography (catheterization of the coronary arteries, coronary angiography) is an examination that allows to assess the condition of the heart arteries. How is coronary angiography done? What are the indications and contraindications for this test?
Coronary angiography: what is it?
Coronary angiographyis a highly specializedstudy , assessing blood flow throughcoronary arteries , i.e. responsible arteries for the blood supply to the heart. If the arteries are narrowed, it causes cardiac ischemia (ischemic heart disease or coronary artery disease). If one of the coronary arteries becomes clogged, it causes a heart attack.
Coronary angiography enables, among others. locating possible strictures in the arteries (e.g. caused by Bürger's disease), assessment of advanced atherosclerotic lesions or assessment of treatment effectiveness, e.g. after ballooning.
Coronary angiography: indications
In patients with stable form of coronary artery disease, coronary angiography is usually a scheduled examination. However, in the case of extremely positive results of other tests (non-invasive) and high cardiovascular risk, it may be an accelerated test.
The indications for urgent coronary angiography apply to patients with various forms of acute coronary syndromes. Then the diagnostic procedure becomes an introduction to, for example, coronary angioplasty or urgent coronary artery bypass surgery.
Another group of indications are cases when it is necessary to assess the condition of coronary arteries in patients prior to elective cardiac surgery - acquired heart defect or congenital heart defect or an aneurysm of the ascending aorta. The condition of the coronary vessels in this group of patients is associated with the extent of elective surgery.
Coronary angiography: the course of the examination
Coronary angiography involves inserting a catheter with a contrast into the artery - femoral, radial or brachial under local anesthesia, thanks to which it is possible to present the state of the arteries on the X-ray screen.
It is an invasive test and therefore carries some risk. It is true, as the cardiologist claims, prof. Andrzej Dyduszyński, the risk is small, but it does exist and every patient who is to undergo coronary angiography should be warned about it. This is especially true for the elderly. Sensitizemaybe the contrast itself, the so-called contrast agent, inserted through the catheter.
This is the smallest problem, however, because at the moment there are over a dozen types of this type of contrasts and it is possible, of course, after appropriate research, to choose the most appropriate one. Generally, these contrasts are divided into ionic and non-ionic. The latter are more expensive, but have fewer side effects.
Coronary angiography: complications
Complications related to coronary angiography are the most common local complications. And it can be:
- hematoma and local bleeding at the arterial puncture site,
- dissection of the artery and the formation of an aneurysm, the so-called pseudoaneurysm,
- arteriovenous fistula,
- discontinuity of an artery,
- blood clot or embolism caused by a clot or torn atherosclerotic plaque,
- limb ischemia,
- infection.
There may, unfortunately, also occur general complications. These, however, largely depend on the initial general he alth of the patient and the wrongly selected contrast agent.
In such cases it may come to:
- neurological (transient) disorders,
- renal failure (contrast nephropathy),
- hives,
- swelling,
- anaphylactic shock,
- increased vasovagal reaction manifested by bradycardia and hypotension.
Patients with numerous internal and cardiological loads may develop cardiovascular complications, which are:
- arrhythmia (atrial fibrillation,
- atrioventricular block, asystole),
- acute circulatory failure (pulmonary edema, shock),
- myocardial infarction,
- stroke,
- damage to large arteries, including the aortic arch, requiring urgent repair surgery.
Coronary angiography: contraindications
As with any other invasive test, there are contraindications here. Prof. However, Dyduszyński strongly emphasizes that, in fact, the only absolute indication for coronary angiography is the lack of the patient's informed consent to the procedure.
However, the relative contraindications include:
- advanced renal failure,
- pulmonary edema,
- severe bleeding disorder,
- active gastrointestinal bleeding,
- recent stroke,
- anemia,
- severe hypertension,
- significant electrolyte disturbances,
- comorbid debilitating disease,
- endocarditis,
- decompensated diabetes (which may be related towith significant obstruction of the arteries, which may increase the risk of their damage during catheter insertion).
The risk is certainly lower when coronary angiography is performed in a facility properly prepared for this type of procedure. An individual approach to the patient is also important, one that will allow you to take into account all the pros and cons.